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Ann Arbor VA hospital one of 3 in Michigan under federal investigation

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A report by the U.S. Department of Veterans Affairs says the Ann Arbor VA Health System should receive a more extensive audit in connection with veteran deaths that may have resulted from long wait times for care. Two other VA facilities in the state are similarly targeted.

The Ann Arbor VA Healthcare System has been targeted for a more extensive audit under an ongoing federal investigation of veteran deaths resulting from long waits for appointments, according to a report released today by the U.S. Department of Veteran Affairs.

Five percent of veterans, or 2,576, at the Ann Arbor VA waited 30 days or more for an appointment. There were 50,019 appointments scheduled in Ann Arbor on May 15, the day of the audit.

In May, a whistle-blower physician at a Phoenix VA hospital charged that long waits to see primary care physicians led to at least 40 unnecessary veteran deaths there.

After outrage over the deaths in Phoenix grew, VA Secretary Eric Shinseki resigned May 30 after ordering an audit of all 151 VA medical centers.

Over the past month, VA officials have targeted at least 42 VA medical centers and more than 50 other facilities nationally for further investigation about appointment wait times and scheduling problems.

The two other VA facilities in Michigan targeted for further investigation are large, community-based outpatient clinics in Muskegon and Lansing, the VA report said.

After undergoing a preliminary audit last month, the Detroit VA Healthcare System was not targeted for a closer audit, the report said.

Two percent of veterans, or 662, at the Detroit VA had appointments scheduled out more than 30 days. Of 42,502 total appointments, Detroit scheduled 41,840 within 30 days, the report said.

National VA guidelines require that veterans receive an appointment within 14 days of the day they want to be seen.

Here are the results of the audit of the two other VA medical centers in Michigan:

At the Battle Creek VA, 4 percent of veterans, or 988, had appointments scheduled out more than 30 days. A total of 22,509 veterans had appointments as of May 15.

At the Saginaw VA, 2 percent of veterans, or 667, had appointments scheduled out more than 30 days. A total of 27,291 veterans had appointments as of May 15.

In a statement, the acting secretary of veterans affairs, Sloan Gibson, said the VA has contacted 50,000 veterans across the country “to get them off of wait lists and into clinics.”

But a VA inspector general report issued last month also noted that one of the problems in the VA system is shortages of physicians, nurses and other caregivers.

“We’ve deployed a dedicated human resources team to support the hiring of additional staff,” Gibson said. “We are using temporary staffing measures, along with clinical and administrative support, to ensure these veterans receive the care they have earned through their service.”

In addition, the new report found the average wait time for a new patient at the Detroit VA is longest of any four in Michigan at 31 days. Second is Ann Arbor VA at 30, followed by Battle Creek at 28 days and Saginaw at 22 days.

By contrast average wait times for new patients at medical centers in Indianapolis and Danville, Ill., is 54 days.

Detroit VA

In a statement last week, Pamela Reeves, M.D., director of the Detroit VA, said her system sees 97 percent of veterans within 14 days of their appointment time request. The Detroit VA operates the John D. Dingell VA Medical Center.

The average wait time is nine days for primary care and 33 days for specialty care, which is below national averages, Reeves said. Those vets who do not receive an appointment before 90 days are placed on the electronic wait list, she said.

“Detroit was audited, along with our two community-based outpatient clinics, and was found to have strong scheduling practices consistent with VHA scheduling directives,” Reeves said.

The Detroit VA statement added: “If a veteran feels as though he or she is not receiving timely or quality care, he/she is encouraged to follow our VA medical center’s process of reporting concerns either to a health care team or to one of our patient advocates.”

Phil Smith, a spokesman for Vietnam Veterans of America in Detroit, said veterans have been complaining for years about long waits and backlogs for appointments at the Detroit VA.

“They have most recently tried changing, but I can tell you it only changes for a little while,” Smith said. “For the most part, they are very active, but they do not like criticism.”

Gibson said the VA has suspended all senior executive bonus payouts this year. Tying financial incentives to meeting the 14-day appointment scheduling goal was one factor that the IG report said could have led executives into allegedly gaming the scheduling system.

Before stepping down, Shinseki also imposed a new appointment policy — the Accelerating Change Initiative — and ordered VA health facilities to more often use private hospitals and physicians if veterans couldn’t get and wanted an appointment within 30 days.

The VA report found that at least 57,436 veterans nationally who are waiting to be scheduled for care. Moreover, another 63,869 veterans who enrolled for health care services who have been waiting for an appointment at least 10 years.

Ann Arbor VA

The Ann Arbor VA provides care to about 65,000 vets in Michigan and northwest Ohio. The system recently has expanded clinics to weekends and evening hours to accommodate increased demand, said Robert McDivitt, director of the Ann Arbor VA.

“When (Ann Arbor) does not offer a particular service, veterans are scheduled to see a community provider,” McDivitt said in a statement last week. “If VA facilities cannot schedule the patient within a reasonable time frame, then arrangements are made for the veteran to be seen by a community provider.”

In a statement Monday, McDivitt confirmed the Ann Arbor VA is one of 112 VA sites identified for further review.

“Although we do not know the reason for the follow up visits or who will be conducting them, we will work in full cooperation with the audit team to address any issues they may have,” McDivitt said.

Reeves said the Detroit VA, which is responsible for 370,000 eligible veterans in the counties of Wayne, Oakland, Macomb and St. Clair, offers private appointments to veterans based on specific needs. She did not provide the number of veterans referred out for care to private health facilities and how much is spent locally.

“We currently have two clinics with patients on the electronic wait list and are contacting veterans by phone to offer non-VA care to patients who are waiting for appointments in those clinics,” Reeves said. “Non-VA care is offered in those instances where appointments are not available in a clinically appropriate time frame.”

But Reeves said most veterans opt to wait for a VA provider rather than accept a private referral. “If non-VA care is accepted, our non-VA care coordinators provide authorizations and coordinate appointments with the Veterans community provider of choice,” she said.

However, one physician who is familiar with the Detroit VA and asked for anonymity said the Detroit VA refers few veterans to private hospitals or doctors. He said many private health care providers also don’t want to take nonemergency referrals from the VA because reimbursement for services can take months.

The physician said the Detroit VA routinely transfers patients with heart conditions to the Ann Arbor VA, where surgeries or cardiac catheterization procedures are performed.

Officials at Henry Ford Hospital and the Detroit Medical Center, the two nearest hospitals to the Detroit VA, said they receive few physician or hospital referrals from the VA.

Shinseki’s new appointment policy indicates the VA wants to take some of the pressure off its hospital system by allowing more veterans to be treated at private hospitals.

The Ann Arbor VA projects to spend $17.8 million this year on non-VA care, McDivitt said.

“This is below the national average because we are a tertiary care center that provides a wide range of specialty services,” McDivitt said.

In 2013, the VA said it spent $4.8 billion on medical care for about 1 million veterans at private hospitals and clinics, amounting to about 10 percent of total VA health care costs. Non-VA outpatient visits grew to 15.3 million in 2013 from 8.9 million in 2008, the VA said.

Caring for 6 million vets

Overall, the VA provides health care to more than 6 million of the 26 million veterans each year. They are seen in 91 million outpatient visits and 960,000 hospitalizations at the nation’s VA medical centers.

Access to mental health services also has been an ongoing problem since the 9/11 terrorist attacks and the military actions in Iraq and Afghanistan.

In 2012, Crain’s reported that the Detroit VA hired 18 additional mental health professionals to help reduce a backlog of veterans waiting for counseling appointments. The mental health appointment backlog has been blamed for contributing to a historically high veteran suicide rate of 18 per day.

The VA report said Detroit’s average mental health wait time for new patients was 19.87 days, Ann Arbor was 26.67, Battle Creek was 22.72 and Saginaw was 20.86.

Established mental health patient waits were 0.36 days for Detroit, 2.45 days for Ann Arbor, 1.64 days for Battle Creek and 0.76 days for Saginaw, the report said.